Palliative Care Physicians' Perceptions of Conditions Required to Provide Early Palliative Care

National strategy for integrating palliative care into standard cardiac care for people living with heart failure: a position statement from the joint working group of the Swiss Societies of Cardiology and Palliative Care

Introduction

Heart failure (HF) causes high symptom burden and shortens life expectancy. Implementation of Palliative Care (PC) concurrently with cardiologic guidelines-directed medical therapy (GDMT) improves quality-of-life (QoL) more than disease-oriented management alone but is underused. To facilitate provision of PC for people living with HF, the Swiss Society of Cardiology (SSC) and the Swiss Society for Palliative Care (palliative.ch) have created joint working-group.

Methods

Dyads representing cardiology and PC from Swiss HF centres have been identified. Through online voting, workshops and Delphi process priority topics for incorporation of PC into standard care for people with HF have been identified.

Results

18 experts, from 8 Swiss HF-centres identified main topics relevant for implementation of PC in usual HF care: timely recognition of unaddressed health-related needs of affected people and their relatives (using validated assessment tools ID-PALL or NAT-PD:CH at least as the triggers evolve), identifying key palliative interventions for care of people living with HF, identifying strategies to facilitate cooperation between specialist PC and cardiology, defining research agenda to investigate efficacy of PC interventions, quality of care criteria, and outcomes of PC provision in Switzerland.

Discussion

Improvement of QoL of people with HF and their relatives could be greater if PC would be integrated in usual care timely. Frequent needs assessment, using validated tools helps to recognize people having unaddressed needs, and helps to replace the outdated, based on risk of dying, involvement of PC. Dialogue between both disciplines is crucial to provide care prolonging life of best quality during the whole journey living with disease.

Timely integration of specialist palliative home care (SPHC) for patients with congestive heart failure, chronic obstructive pulmonary disease and dementia: qualitative evaluation of the experiences of SPHC physicians in the KOPAL trial

OBJECTIVE

Chronic non-malignant diseases (CNMDs) are under-represented in specialist palliative home care (SPHC). The timely integration of SPHC for patients suffering from these diseases can reduce hospitalisation and alleviate symptom burdens. An intervention of an SPHC nurse-patient consultation followed by an interprofessional telephone case conference with the general practitioner (GP) was tested in the KOPAL trial ('Concept for strengthening interprofessional collaboration for patients with palliative care needs'). As part of the trial, the aim of this study was to gain in-depth insights into SPHC physicians' perspective on care with and without the KOPAL intervention for patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and dementia (D).

DESIGN

Qualitative evaluation of the KOPAL intervention from the perspective of SPHC physicians as part of the KOPAL trial. Thematic-focused narrative interviews analysed with grounded theory.

SETTING

We conducted the KOPAL study and its qualitative evaluation in Lower Saxony and the greater Hamburg area, Germany.

PARTICIPANTS

11 physicians from 14 SPHC teams who participated in the trial were interviewed.

RESULTS

A grounded theory of the necessity of collaboration between GPs and SPHC teams for patients with CHF, COPD and dementia was developed. From the perspective of SPHC physicians, patients with CNMD are generally difficult to manage in GP care. The timing of SPHC initiation is patient-specific, underscoring the need for collaboration between SPHC physicians and GPs. However, the primary mandate for healthcare should remain with GPs. SPHC physicians actively seek collaboration with GPs (eg, through the KOPAL intervention), viewing themselves as advisors for GPs and aspiring to collaborate as equal partners.

CONCLUSION

Effective communication and the negotiation of future interprofessional collaboration are essential for SPHC teams.

TRIAL REGISTRATION NUMBER

DRKS00017795.

"You don't want to know just about my lungs, you…want to know more about me". Patients and their caregivers' evaluation of a nurse-led COPD supportive care service

AIM

To evaluate a nurse-led model of supportive care in a COPD outpatient service from patient and caregiver perspectives.

DESIGN

Case study methodology.

METHODS

Data were collected from semi-structured interviews with patients (n = 12) and caregivers (n = 7) conducted between April 2020 and September 2022. A purposive sampling strategy was used. Interviews were transcribed verbatim and analysed using content analysis with an inductive approach. COREQ guidelines informed reporting of this study.

RESULTS

Eight categories were identified from the data evaluating of the model of care relating to the most helpful aspects of COPD supportive care and suggested improvements to the model of care. The categories were: guidance with managing symptoms; participating in advance care planning; home visiting; expert advice; continuity and trust; caring; caregiver support and improvements to the model of care.

CONCLUSION

In a nurse-led model of COPD supportive care, what patients and caregivers valued most was expert advice and guidance with symptom management, flexible home visiting, participation in advance care planning, caring and continuity within an ongoing trusted therapeutic relationship. Understanding what patients and caregivers value most is essential in designing and delivering models of care that meet the needs of patients living with chronic, life-limiting illness.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses can lead effective models of supportive care that offer valuable support to patients living with COPD and their caregivers.

Predictive Models for Palliative Care Needs of Advanced Cancer Patients Receiving Chemotherapy

CONTEXT

Early palliative care is recommended within eight-week of diagnosing advanced cancer. Although guidelines suggest routine screening to identify cancer patients who could benefit from palliative care, implementing screening can be challenging due to understaffing and time constraints.

OBJECTIVES

To develop and evaluate machine learning models for predicting specialist palliative care needs in advanced cancer patients undergoing chemotherapy, and to investigate if predictive models could substitute screening tools.

METHODS

We conducted a retrospective cohort study using supervised machine learning. The study included patients aged 18 or older, diagnosed with metastatic or stage IV cancer, who underwent chemotherapy and distress screening at a designated cancer hospital in Japan from April 1, 2018, to March 31, 2023. Specialist palliative care needs were assessed based on distress screening scores and expert evaluations. Data sources were hospital's cancer registry, health claims database, and nursing admission records. The predictive model was developed using XGBoost, a machine learning algorithm.

RESULTS

Out of the 1878 included patients, 561 were analyzed. Among them, 114 (20.3%) exhibited needs for specialist palliative care. After under-sampling to address data imbalance, the models achieved an Area Under the Curve (AUC) of 0.89 with 95.8% sensitivity and a specificity of 71.9%. After feature selection, the model retained five variables, including the patient-reported pain score, and showcased an 0.82 AUC.

CONCLUSION

Our models could forecast specialist palliative care needs for advanced cancer patients on chemotherapy. Using five variables as predictors could replace screening tools and has the potential to contribute to earlier palliative care.

Quality of referrals to specialist palliative care and remote patient triage - a cross-sectional study

PURPOSE

Choosing the optimal moment for admission to palliative care remains a serious challenge, as it requires a systematic identification of persons with supportive care needs. Despite the screening tools available for referring physicians, revealing the essential information for preliminary admission triage is crucial for an undisturbed qualification process. The study was aimed at analysing the eligibility criteria for specialist palliative care disclosed within provided referrals, expanded when necessary by documentation and/or interview.

METHODS

Referral forms with the documentation of 300 patients consecutively referred to the non-profit in-patient ward and home-care team in Poland were analysed in light of prognosis, phase of the disease and supportive needs.

RESULTS

Half of the referrals had the sufficient information to make a justified preliminary qualification based solely on the delivered documentation. The majority lacked performance status or expected prognosis. Where some information was revealed, two-thirds were in a progressing phase of the disease, with a within-weeks life prognosis. In 53.7%, no particular reason for admission was given. Social problems were signalled as the only reason for the admission in 7.7%. Twenty-eight percent were labelled as "urgent"; however, 52.4% of them were triaged as "stable" or disqualified. Patients referred to a hospice ward received complete referral forms more often, containing all necessary information.

CONCLUSIONS

General physicians need practical tips to facilitate timely referrals and unburden the overloaded specialist palliative care. Dedicated referral forms extended by a checklist of typical patients' concerns should be disseminated for better use of these resources.